Spinous process device and method of use

ABSTRACT

A spinous process device and method are disclosed. The device includes a first plate having a first part slidably coupled to a second part, a second plate having a third part slidably coupled to a fourth part, and first and second connector devices configured to be placed through openings created in spinous processes and rotatably couple respective first and second parts to third and fourth parts of the first and second plates together allowing angular displacement of the second plate with respect to the first plate and secure the spinous processes between the first and second plates.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority to U.S. Provisional PatentApplication Nos. 61/188,417, filed Aug. 8, 2008, 61/194,983, filed Oct.1, 2008, both entitled “Spinous Process Device”, and 61/167,067, filedApr. 6, 2009, entitled “Spinous Process Device And Method Of Use”, thedisclosures of which are incorporated herein by reference in theirentirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

Embodiments of the present invention generally relate to the field ofsurgery, and more specifically, to a clamping device for securingvarious parts of a spinous process.

2. Background of the Invention

The spinous process of a vertebra is directed backward and downward fromthe junction of the laminae (in humans), and serves for the attachmentof muscles and ligaments. A typical vertebra consists of two essentialparts: an anterior (front) segment, which is the vertebral body; and aposterior part—the vertebral (neural) arch—which encloses the vertebralforamen. The vertebral arch is formed by a pair of pedicles and a pairof laminae, and supports seven processes, four articular, twotransverse, and one spinous, the latter also being known as the neuralspine.

When the vertebrae are articulated with each other, the bodies form astrong pillar for the support of the head and trunk, and the vertebralforamina constitute a canal for the protection of the medulla spinalis(spinal cord). In between every pair of vertebrae are two apertures, theintervertebral foramina, one on either side, for the transmission of thespinal nerves and vessels.

Two transverse processes and one spinous process are posterior to(behind) the vertebral body. The spinous process comes out the back, onetransverse process comes out the left, and one on the right. The spinousprocesses of the cervical and lumbar regions can be felt through theskin. Superior and inferior articular facets on each vertebra act torestrict the range of movement possible. These facets are joined by athin portion of the neural arch called the pars interarticularis.

Further features and advantages of the invention, as well as structureand operation of various embodiments of the invention, are disclosed indetail below with references to the accompanying drawings.

SUMMARY OF THE INVENTION

In some embodiments, the present invention relates to a spinous processdevice including a first plate having a first part slidably coupled to asecond part, a second plate having a first part slidably coupled to asecond part, and first and second connector devices configured to beplaced through openings created in spinous processes and rotatablycouple respective first and second parts to third and fourth parts ofthe first and second plates together allowing angular displacement ofthe second plate with respect to the first plate and secure the spinousprocesses between the first and second plates.

In many embodiments, the device further includes first and secondlocking mechanisms configured to lock the first and second parts and thethird and fourth parts a desired distance apart.

In many embodiments, each plate includes an interior portion having aplurality of protrusions configured to interact with the bony matter.

In many embodiments, upon connection of the first and second platesusing the first and second connector devices, the first and secondplates are configured to be parallel to each other.

In many embodiments, upon connection of the first and second platesusing the first and second connector devices, the first and secondplates are configured to be disposed at an angle with respect to eachother.

In many embodiments, the connector devices are selected from a groupconsisting of: screws, bolts, pins, springs, rods, and other suitabledevices.

In many embodiments, each of the first and second parts includes anopening configured to accommodate the first and second connector device.

In many embodiments, at least one of the first part and the second partincludes an angularly disposed flange configured to form an angle withat least one of the first part and the second part.

In some embodiments, the present invention relates to a spinous processdevice including a first portion translationally coupled to a secondportion, first and second bone attachment mechanisms coupled to thefirst and second portions and configured to secure the first and secondportions to first and second spinous processes, a translationalmechanism configured to allow the first and second portions to translatewith respect to each other, varying the distance between the first andsecond bone attachment mechanisms, and a locking mechanism configured tolock the first and second portions at the desired distance between thefirst and second bone attachment mechanisms.

In many embodiments, the first bone attachment mechanism includes afirst rod configured to be inserted into an opening created in the firstspinous process and a clamping washer configured to couple with thefirst rod and secure the first portion to the first spinous process, thesecond bone attachment mechanism includes a second rod configured to beinserted into an opening created in the second spinous process and aclamping washer configured to couple with the second rod and secure thesecond portion to the second spinous process.

In many embodiments, the device further includes a plurality ofprotrusions disposed on the first and second portions configured tointeract with the first and second spinous processes.

In some embodiments, the present invention relates to a spinous processdevice including a fixation plate having a plurality of slottedopenings, a plurality of fixation devices adjustably coupled to theslotted openings and configured to be placed through openings created ina first and second spinous processes, and clamping washers configured tocouple with the fixation devices and secure the fixation plate to thespinous processes in the desired compression or distraction position.

In many embodiments, the fixation devices are selected from a groupconsisting of: screws, bolts, pins, springs, rods, and other suitabledevices.

In some embodiments, the present invention relates to a spinous processdevice including a first plate configured to be pivotally coupled to asecond plate, a clamping mechanism configured to couple the first plateto the second plate upon pivotal movement of the plates toward eachother, and a plurality of protrusions disposed on at least one of theplates and configured to interact with spinous processes to be securedby the plates, wherein the spinous processes are positioned between theplates.

In some embodiments, the present invention relates to a spinous processdevice including a first plate having a first part rotatably andtranslationally coupled to second part along a first pivot axis, a firstarm extending transversely from the first part relative to the firstpivot axis configured to extend between a first and second spinousprocesses, a second plate having a third part rotatably andtranslationally coupled to a fourth part along a second pivot axis, asecond arm extending transversely from the third part relative to thesecond pivot axis configured to extend between the first and secondspinous processes, and a coupling mechanism configured to engage thefirst and second arms and angularly and translationally couple the firstand second plates.

In many embodiments, the first arm includes a rod and the couplingmechanism includes a clevis having a body with an aperture, the bodybeing coupled to the second arm and the aperture being coupled to therod, wherein the distance between the first plate and the second plateis adjustable by sliding the rod relative to the second arm while therod extends through the aperture of the clevis, and wherein the firstpart and the third part are rotatable relative to each other by rotatingthe second arm about the rod within aperture of the clevis.

In many embodiments, the coupling mechanism includes a body having afirst coupler opening, a second coupler opening, a third coupler openingand a base opposite the first coupler opening, the second and thirdcoupler openings being on opposite sides of the body and configured toreceive the first and second arm and a securing screw coupled to thefirst couple opening configured to clamp the first and second armsbetween the securing screw and the base.

In many embodiments, the first part includes a first extended portionreceivable into a hollow interior portion of the second part and thethird part includes a second extended portion receivable into a hollowinterior portion of the fourth part, the device further including afirst securing screw coupling the first part to the second part and asecond securing screw coupling the third part to the fourth part.

In many embodiments, at least one of the first part, second part, thirdpart and fourth part includes an interior surface with a plurality ofprotrusions configured to interact with the spinous process.

In some embodiments, the present invention relates to a spinous processdevice including a first plate extending along a first pivot axisincluding a first part configured to abut a first spinous process and asecond part configured to abut a second spinous process, wherein thefirst part is slidably coupled to the second part along the first pivotaxis and the second part is rotatable relative to the first part, asecond plate extending along a second pivot axis including a third partconfigured to abut the first spinous process opposite the first part anda fourth part configured to abut the second spinous process opposite thesecond part, wherein the third part is slidably coupled to the fourthpart along the second pivot axis and the fourth part is rotatablerelative to the third part, and a coupling mechanism configured tocouple the first and second plates such that the distance between thefirst plate and the second plate is adjustable and the first part andthe third part are rotatable relative to each other.

In many embodiments, the first part includes a first member extendingtoward the third part, and the third part includes a second memberextending toward the first part, wherein the first member is coupled tothe second member with the coupling mechanism that allows the firstmember to translate axially and rotate relative to the second member toestablish a spaced distance between the first part and the third partand to establish an angular relationship between the first part and thethird part.

In many embodiments, the coupling mechanism includes a clevis, theclevis comprising an aperture, a body and a threaded end, wherein thefirst member is a rod and the second member is an arm, the rod beingcoupled to the arm with the rod extending through the aperture andtranslating axially through the aperture to establish a spaced distancebetween the first part and the third part, and the arm rotates about theclevis body to establish an angular relationship between the first partand the third part.

In many embodiments, the coupling mechanism includes a hollow cylinderhaving a first opening, a second opening, and a third opening, the firstmember is a first arm and the second member is a second arm comprising athreaded hole, wherein the first plate is coupled to the second platewith the first arm received in the second opening of the hollowcylinder, the second arm received in the third opening of the hollowcylinder, and wherein a securing screw extends into the first opening ofthe hollow cylinder and engages the threaded hole in the second arm.

In many embodiments, at least one of the first part, second part, thirdpart and fourth part includes an interior surface with a plurality ofprotrusions configured to interact with the spinous processes.

In some embodiments, the present invention relates to a method ofclamping adjacent spinous processes including providing a spinousprocess device including a first plate having a first part slidablycoupled to a second part, a second plate configured to be placedoppositely to the first plate and having a third part slidably coupledto a fourth part, first and second connector devices configured to beplaced through openings created in the spinous processes and couplefirst and second parts of the first plate to second and third parts ofthe second plate together, creating openings in the spinous processes ata predetermined distance apart to receive the first and second connectordevices, adjusting the distance between the first and second parts ofthe first plate and the second and third parts of the second plate sothat the first and second connector devices are aligned with theopenings in the spinous processes, the spinous processes being disposedbetween the plates, and securing the first and second plates to thespinous processes with the first and second connector devices, therebycompressing and clamping the spinous processes between the first andsecond plates.

In some embodiments, the present invention relates to a method ofclamping adjacent spinous processes including providing a spinousprocess clamping device including a first part and a second partslidingly coupled to form a first plate, a third part and a fourth partslidingly coupled to form a second plate, a coupling mechanismconfigured to couple the first and second plates to allow for adjustmentof distance and relative rotation between the first and second plates,inserting the spinous process clamping device adjacent at least twoadjacent spinous process with the first plate provided on one side ofthe two adjacent spinous processes and the second plate provided on theother side of the two adjacent spinous process, clamping the first plateand second plates to the opposite sides of the two adjacent spinousprocesses, wherein said clamping includes adjusting lengths of the firstplate and the second plate by sliding the first part relative to thesecond part and sliding the third part relative to the fourth part,respectively, to a desired length for placement of the first and secondplates against the two adjacent spinous processes, adjusting an angularrelationship of the first and second parts of the first plate bytwisting the first part relative to the second part, and adjusting theangular relationship of the third and fourth parts of the second plateby twisting the third part relative to the fourth part, to conform tothe shape of the adjacent spinous processes, and adjusting an angularrelationship of the first plate relative to the second plate via thecoupling mechanism connecting the first plate to the second plate, toconform to the shape of the adjacent spinous processes.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the present invention are described with reference to theaccompanying drawings. In the drawings, like reference numbers indicateidentical or functionally similar elements. Additionally, the left-mostdigit(s) of a reference number identifies the drawing in which thereference number first appears.

FIG. 1 is a perspective view of an exemplary spinous process clamp,according to some embodiments of the present invention.

FIG. 2 is another perspective view of the spinous process clamp shown inFIG. 1.

FIG. 3 is a perspective view of another exemplary spinous process clamp,according to some embodiments of the present invention.

FIG. 4 is another perspective view of the spinous process clamp shown inFIG. 3.

FIG. 5 is a perspective view of yet another exemplary spinous processclamp, according to some embodiments of the present invention.

FIG. 6 is another perspective view of the spinous process clamp shown inFIG. 5.

FIG. 7 is a perspective view of yet another exemplary spinous processclamp, according to some embodiments of the present invention.

FIG. 8 is another perspective view of the spinous process clamp shown inFIG. 7.

FIG. 9 is a perspective view of another exemplary spinous process clamp,according to some embodiments of the present invention.

FIG. 10 is a perspective view of yet another exemplary spinous processclamp, according to some embodiments of the present invention.

FIG. 11 is a perspective view of yet another exemplary spinous processclamp, according to some embodiments of the present invention.

FIGS. 12-27 are various views of another exemplary embodiment of thespinous process clamp, according to some embodiments of the presentinvention.

FIGS. 28 a-28 c are various views of an exemplary hexaglobe screw thatcan be used in connection with the present invention's spinous processclamps, according to some embodiments of the present invention.

FIG. 29 is an exploded view of another exemplary spinous process clamphaving a curved flange for mating to at least a portion of a spinousprocess, according to some embodiments of the present invention.

FIGS. 30 a-30 c illustrate the spinous process clamp shown in FIG. 29coupled to the spinous process.

FIG. 31 illustrates a perspective view of a spinous process clampaccording to another embodiment for mating to at least a portion of aspinous process.

FIG. 32 is an exploded view of the spinous process clamp of FIG. 31 formating to at least a portion of a spinous process.

FIGS. 33 a-33 b illustrate perspective views of a first sliding part, ormember, of the spinous process clamp of FIG. 31.

FIGS. 34 a-34 b illustrate perspective views of a second sliding part,or member, of the spinous process clamp of FIG. 31.

FIGS. 35 a-35 b illustrate perspective views of a third sliding part, ormember, of the spinous process clamp of FIG. 31.

FIGS. 36 a-36 b illustrate perspective views of a fourth sliding part,or member, of the spinous process clamp of FIG. 31.

FIGS. 37 a-37 b illustrate perspective views of a securing screwconfigured to couple members of the spinous process clamp of FIG. 31.

FIG. 38 illustrates a perspective view of a clevis configured to couplemembers of the spinous process clamp of FIG. 31.

FIG. 39 illustrates a perspective view of a nut configured to couple aclevis and members of the spinous process clamp of FIG. 31.

FIG. 40 illustrates a perspective view of a spinous process clampaccording to another embodiment for mating to at least a portion of aspinous process.

FIG. 41 is an exploded view of the spinous process clamp of FIG. 40 formating to at least a portion of a spinous process.

FIGS. 42 a-42 b illustrate perspective views of a first sliding part, ormember, of the spinous process clamp of FIG. 40.

FIG. 43 illustrates a perspective view of a third sliding part, ormember, of the spinous process clamp of FIG. 40.

FIG. 44 illustrates a perspective view of a coupler configured to couplemembers of the spinous process clamp of FIG. 40.

FIG. 45 illustrates a perspective view of a securing screw configured tocouple members of the spinous process clamp of FIG. 40.

DETAILED DESCRIPTION OF THE INVENTION

As required, detailed embodiments of the present invention are disclosedherein; however, it is to be understood that the disclosed embodimentsare merely examples of the invention, which may be embodied in variousforms. Therefore, specific structural and functional details disclosedherein are not to be interpreted as limiting, but merely as a basis forthe claims and as a representative basis for teaching one skilled in theart to variously employ the present invention in virtually anyappropriately detailed structure.

Embodiments of the present invention relate to a spinal process clamp.The clamp can be used during surgical techniques such as preservation orremoval of the posterior spinous ligament, unilateral vs. bilateraldissection, bony preparation techniques, grafting technique, and othertechniques. The clamp can be used medially or laterally. The clamp canbe coupled through spinous process, between spinous process,superior/inferior to the spinous process, posterior to the spinousprocess, or anywhere else. The coupling mechanism can include a threadednut and bolt through the dorsal plane, a ratchet, a threadedinterference screw in the axial plane (direct A/P).

The clamp can be also translated using various translation and lockingmechanisms. The translation mechanism includes slotted holes, slidingwashers, interlocking plates, coupled rods, or any other devices. Thelocking mechanism includes a ratchet, interference screws, teeth withcompression screw, or any other locking mechanisms.

FIGS. 1-2 illustrate an exemplary embodiment of a spinous process clamp100, according to some embodiments of the present invention. The clamp100 uses threaded screws to couple and compress the plates to thespinous process. The clamp 100 is stable and is easy to manufacture.

The clamp 100 includes a first curved plate 102 and a second curvedplate 104 coupled together via threaded screws 110 (a, b). The curvedplates 102, 104 include two end portions configured to accommodateplacement of screws 110 and a middle portion disposed between the endportions. In some embodiments, the end portions of the plates 104 areconfigured to be enlarged so as to accommodate openings for theplacement of threaded screws 110. In some embodiments, one of theopenings can be enlarged (see, numeral 112) so as to accommodatesliding/translation of the screws 110 and thus, adjustable securing ofthe screw 110. Such adjustable securing allows for adjusting thedistance between the screws 110 during installation of the clamp 100. Toallow for the adjustable securing of the threaded screw 110 b, the plate102 can include a sliding nut 221 that can be securing within a recess206 disposed on the plate 102. The sliding nut 221 includes a threadingthat accommodate threads of the threaded screw 110 b. Screw 110 a can beconfigured to be threadedly secured within a corresponding threadedopening of the plate 102.

In some embodiments, to further secure plates 102, 104, each plate caninclude protrusions 122 that are disposed on the interior facets of theplates 102, 104, as shown in FIG. 1. Such protrusions 122 can beconfigured to extend toward each other when the plates 102, 104 arecoupled together using screws 110. The protrusions 122 are configured tocreate additional friction between the bony matter and the plates. Theprotrusions 122 can be sharp and have a conical, pyramidal, or any otherdesired shape. The distance between the plates 102, 104 can be adjustedupon securing the plates 102, 104. This process is referred to ascompression. The screws 110 are configured to include recessesconfigured to accommodate use of special type wrenches for rotating thescrews. The recesses can be hexagonal (as shown in FIG. 1), hexaglobal(which, in some embodiments, can be a combination of hexagonal andstar-like shape, as shown in FIGS. 28 a-c), or any other type ofrecesses. In some embodiments, in order to secure the clamp 100 to thebone, two holes corresponding in diameter to the diameter of the screwsare created in the bony matter. The plates are attached at oppositesides of the bones and the screws are protruded through the openings inthe plates and the created holes. Then, the screws are threadedlysecured to the plates.

The clamp 100 is useful in scenarios where installation of parallelplates 102, 104 conforms to the human anatomy and the recess 206 of theplate 102 does not interfere with adjacent levels after compression. Insome embodiments, the lateral locking screws may be difficult to tightenand holes made in spinous process may weaken the bone.

FIGS. 3-4 illustrate another exemplary spinous process clamp 300,according to some embodiments of the present invention. Clamp 300 isconfigured as a ball-and-socket design and conforms to the anatomy ofthe patient. The clamp 300 includes stationary portions 302 (a, b) andmobile portions 304 (a, b,). The stationary portions 302 include screwsecuring portions 315 (a, b) coupled to respective holder portions 319(a, b). The mobile portions 304 also include screw securing portions 317(a, b) coupled to respective sliding rod portions 321 (a, b). The holderportions 317 are configured to have a hollow interior and furtherconfigured to be larger in diameter than the rod portions 321, whereinthe rod portions 321 are configured to slide inside the hollow interiorsof the respective holder portions 317. The holder portions 319 furtherinclude clamping screws 312 (a, b), respectively, that are configured tosecure the rod portions 321 once they are inserted into the hollowholder portions 319. Such sliding arrangement between stationaryportions 302 and mobile portions 304 allows adjustment of length betweenrespective screw securing portions 315 and 317, hence, the device 300can be configured to span a greater distance between sections of a bonymatter. The screw securing portions 315 and 317 are configured in asimilar fashion as the screw securing portions shown in FIGS. 1-2. Also,similar to the device 100 shown in FIGS. 1-2, the screw securingportions 315 and 317 include protrusions 322 disposed on inner surfacesof the portions 315 and 317 and configured to face each other when thedevice 300 is assembled. The protrusions 322 are configured to becoupled to the bony matter and prevent slippage of the device 300. Theportions 319 and 321 can be configured to have a parallelepiped,cylindrical, or any other desired shape. The screw securing portions315, 317 can have a round, oval, square, rectangular, or any otherdesired shape.

The following are some of the advantages of the device 300 shown inFIGS. 3-4. The ball-and-socket design of the device 300 allows fixationsurfaces to conform to the anatomy of the bony matter. Additionally,dynamic struts (portions 319, 321) allow for compression and distractionwithout interference with the adjacent structures. Also, directposterior interference screw (screws 312) facilitates simple locking ofthe translation. The device 300's non-incremental translation allows forinfinite adjustability.

FIGS. 5-6 illustrate another exemplary spinous process clamp/device 500,according to some embodiments of the present invention. The clamp 500has a narrow profile, does not include additional locking steps and doesnot interfere with adjacent anatomy. The device 500 uses mating“dovetail” plates having ratchets in order to achieve controlledcompression and distraction. Apposing plates of the device 500 arecoupled with a ratcheting snap ring and boss that automatically lockswhen compressed.

As shown in FIGS. 5-6, the device 500 includes plates 502(a, b) that areconfigured to appose each other when the device 500 is assembled. Theplates 502 are coupled together using screws (or other connectiondevices) 504 (a, b). In some embodiments, the plates 502 are configuredto be parallel to each other when coupled together using screws 504. Insome embodiments, the plates 502 can be disposed at an angle with regardto each other when coupled together. The screws 504 are configured tocouple plates 502 at opposite ends of the plates 502. Each one of theplates 502 includes a ratcheting mechanism 510 that is configured toadjust distance between the screws 504. The ratcheting mechanism 510includes a plurality of ratchets that allow step-wise increase indistance between the screws 504.

FIGS. 7-8 illustrate another exemplary spinous process clamp 700,according to some embodiments of the present invention. The clamp 700includes sliding plates 702 and 704 that are configured to appose eachother and coupled to each other using screws or any other connectionmeans. The clamp 700 is configured to be coupled with an interspinousdevice in order to help support a segment. The clamp 700 includessimilar translation and fixation mechanism discussed with regard toFIGS. 1-6 above. Each sliding plate 702, 704 includes sliding ramps 712(a, b, c, d) that are disposed in the mid-section of the plates andallows a back-and-forth translation of the plates. The clamp 700 isconfigured to provide additional support to an interspinous graft anddoes not interfere with adjacent levels.

FIG. 9 illustrates yet another exemplary spinous process device 900,according to some embodiments of the present invention. The device 900is a segmental spinous process plate which allows for compression ordistraction. Stair-step/off-set design allows for easier use on multiplesegments. Fixation of device 900 can be done through a hole in thespinous process. In some embodiments, the device 900 can be used forplacement of two plates with connection through the interspinousligament. The device 900 can be placed laterally, thereby preservingspinous process ligaments. It further allows for an infinite adjustmentduring compression or distraction fixation. In some embodiments, thedevice 900 can be secured through holes within spinous process andallows a multi-level use.

The device 900 includes a first portion 902 and a second portion 904.The portions 902 and 904 are configured to be slidingly coupled to eachvia a translational mechanism 920. The translational mechanism 920 isconfigured to allow portions 902, 904 to translate with respect to eachother, thus, varying the distance between bone attachment mechanisms 908(a, b). Upon achieving a desired distance between bone attachmentmechanisms 908, the portions 902, 904 are configured to be secured toeach other using a clamping screw 924. To release the portions 902, 904from one another, the screw 924 is released. The bone attachmentmechanisms 908 include rods 912 (a, b) configured to be coupled to theportions 902, 904, respectively. The mechanisms 908 (a, b) furtherinclude clamping washers 916 (a, b). The washers 916 (a, b) areconfigured to be securely fastened to the respective rods 912 (a, b) andthus, secure the device 900 to the bony matter in a desired location.Similarly to the devices described above, the portions 902, 904 and/orthe washers 916 (a, b) can include a plurality of protrusions 922 thatare configured to prevent slippage of the device 900 along the bonymatter. As stated above, the use of the translational mechanism 920allows fixation of the device 900 to the boney matter at any place,thereby spanning the desired distance between bone segments.

FIG. 10 illustrates yet another exemplary spinous process fixationdevice 1000, according to some embodiments of the present invention. Thedevice 1000 includes a main plate 1002 having a plurality of openings1006 (a, b, c). Each of the openings 1006 is configured to be contouredto accommodate placement of fixation devices/screws/bolts 1004 (a, b),as shown in FIG. 10. As can be understood by one skilled in the art, thefixation or connector devices can be screws, bolts, pins, springs, rods,or any other connector devices. To install the device 1000 to thespinous process, a surgeon (or any other medical professional) createstwo openings in the bony matter, places the main plate 1002 insertsfixation devices 1004 (a, b) through the openings 1006 (a, b, c) and thecreated openings in the bony matter and secures them with clampingwashers 1008 (a, b) (similar to those shown in FIG. 9). The device 1000provides for a simple slotted plate that can be attached through thespinous process. The device 1000 can be configured to allow for severalother options including: 1) using two plates with attachment throughspinous process; 2) attaching a spiked device into slots and attachingtwo plates through the interspinous ligament. The device 1000 can beplaced laterally, thereby preserving spinous process ligaments. In someembodiments, it also allows to incrementally adjust for compression ordistraction fixation. Similarly to the devices described above, theplate 1002 and/or the washers 1008 can include a plurality ofprotrusions that are configured to prevent slippage of the device 1000along the bony matter.

FIG. 11 illustrates yet another exemplary spinous process device 1100,according to some embodiments of the present invention. The device 1100includes two hingedly coupled plates 1102 (a, b). In some embodiments,the plates 1102 have a butterfly shape and are coupled using a hinge1104 that is disposed near a narrower segment of the plates 1102 so asnot to interfere with the attachment to the bony matter. To install thedevice 1100, the device is placed around the bone and then the platesare pivoted to close the “butterfly wings” of the plates 1102 around thebone. In some embodiments, the interior portions of the plates 1102include protrusions 1122 (similar to the protrusions of the abovedevices shown in FIGS. 1-10) that are configured to prevent slippage ofthe plates 1102. The plates 1102 further include a clasping mechanism1104 that upon closing holds the plates together.

The device 1100 allows posterior implant approach between spinousprocesses through a smaller incision. In some embodiments, the device1100 can be secured to spinous processes without creating holes throughspinous process. It also allows a multi-level use. In some embodiments,interspinous process placement does not interfere with posteriorinstrumentation (i.e. pedicel screws).

FIGS. 12-27 illustrate another exemplary spinous process device 1200,according to some embodiments of the present invention. The device 1200is configured to incorporate some of the features of the devicesdescribed above with regard to FIGS. 1-11. The device 1200 includes afirst plate 1202 a and a second plate 1202 b that are angularly coupledto each other via connecting screws/bolts/devices 1220 a, 1220 b. Eachplate 1202 is configured to include sliding parts 1210 and 1212. Theparts 1210 (a, b) and 1212 (a, b) are configured to be translationallycoupled in the mid-section of the plates 1202 (a, b), thereby allowadjustment of distance between the connecting devices 1220. To secure aparticular distance between the connecting devices 1220 (a, b), each ofthe plates 1202 (a, b) includes a securing screw 1218. This arrangementis similar to the one shown in FIGS. 3-4. In some embodiments, a portionof the part 1210 (a, b) is configured to fit inside an interior of atleast a portion of the part 1212 (a, b) and allow for a translationalmovement of the parts 1210 and 1212 with respect to each other, as shownin FIG. 12. Upon translating the parts to a desired distance, arotational force is applied to the screw 1218 to secure such distance.Each of the plates 1202 include interior and exterior portions. Theinterior portions are configured to be placed adjacent to the bone andface each other when the device 1200 is attached to the bone. Theinterior portions further include protrusions 1222 (similar toprotrusions shown in FIGS. 1-11) that are configured to prevent slippageof the plates 1202 when the latter are attached to the bone.

FIGS. 26-27 illustrate parts 1210 and 1212, respectively, of the plates1202, 1204. Referring to FIG. 26, the part 1210 includes an opening 2610for insertion of the screw 1220 (not shown), and a plurality ofprotrusions 1222 disposed on an interior portion of the part 1210. Thepart 1210 also includes a hollow interior 2616 that is configured toaccommodate placement of an extended portion 2714 of the part 1212(shown in FIG. 27). The part 1210 also includes an opening 2614configured to accommodate insertion of the screw 1218 for securing theparts 1210 and 1212 together. In some embodiments, the interior portion2616 can include rail(s) that are configured to mate with correspondingrail(s) of the extended portion 2714 of the part 1212 to allow forsmoother sliding of the extended portion 2714 inside the interiorportion 2616. The part 1210 further includes a slot 2618 that isconfigured to accommodate insertion of a locking clip 2512 (shown inFIG. 25). The slot 2618 is configured to include locking flanges 2715(better shown in FIG. 27) for interlocking the locking clip 2512. Thelocking clip 2512 is configured to provide additional security to thescrew 1218 (shown in FIG. 24).

Referring to FIG. 25, the clip 2512 includes an opening 2516 that isconfigured to accommodate placement of the screw 1218. In someembodiments, the opening 2516 can be configured to include threads thatare configured to correspond to allow a threaded engagement of the screw1220 to the clip 2512. The clip 2512 further includes a locking spring2514 that is configured to interact with the flanges 2715 of the slots2618 (shown in FIG. 26) and 2718 (shown in FIG. 27) and snap into place,once the clip 2512 is inserted into slots 2618, 2718. The openings 2516of the clip 2512 is configured to align with the openings 2610, 2714 ofthe respective parts 1210, 1212.

Referring to FIG. 27, the part 1212 is illustrated. The part 1212 issimilar to the part 1210, except that it includes the extended portion2714 that is configured to be inserted into the interior portion 2612 ofthe part 1210. The extended portion 2714 may also includes ridges 2717that are configured to interact with the locking screw 1218 in order tosecure a particular distance between the parts 1210 and 1212.

FIGS. 19-23 illustrate various perspective assembled and exploded viewsof the device 1200. As illustrated, the plates 1202 are coupled togetherusing screws 1220 and clips 2512. The distances between parts 1210 and1212 are configured to be adjusted using translational mechanisms andscrews 1218, as shown and described in FIGS. 26-27. In some embodiments,the plates 1202 are further configured to be disposed at an angle withregard to each other. This means that at least a portion of one plate1202 can be disposed closer to at least a portion of another plate 1202,as shown in FIGS. 14-18. In some embodiments, such angular displacementis accomplished when the first part 1210 b and second part 1212 b ofplate 1202 b are rotatably coupled to a head of the screws 1220 a, 1220b, which allows pivoting of the plate 1202 b about the head of the screw1220 (as shown in FIGS. 14 and 17). In some embodiments, such angulardisplacement is accomplished via placement of an angulation block 1302(as shown in FIG. 13) that allows pivoting of the plates 1202 about ahead of the screw 1220, once the screw 1220 is inserted through theopenings 2610, 2714 in the plates 1202. The block 1302 is inserted intoone or both of the parts 1210, 1212 around the openings 2610, 2714 andallows for pivotal motion of the plates with respect to each other. Insome embodiments, the angulation of the plates 1202 can be between 15degrees to 30 degrees. Angular disposition of the plates 1202 withrespect to each other allows accommodation of various anatomies. Theinstallation process of the device 1200 is similar to the installationprocess of the devices described above with regard to FIGS. 1-11.

FIG. 29 is an exploded view of another example spinous process device2900, according to some embodiments of the present invention. The device2900 is similar to the device 1200 shown in FIGS. 12-27. The device 2900includes a first plate 2902 a and a second plate 2902 b that are coupledto each other via connecting screws/bolts/devices 2920 a, 2920 b. Insome embodiments, the plates 2902 can be angularly coupled to eachother. Each plate 2902(a, b) is configured to include sliding parts2910(a, b) and 2912(a, b), respectively. The parts 2910 and 2912 areconfigured to be translationally coupled in the mid-section of theplates 2902, thereby allow adjustment of distance between the connectingdevices 2920. To secure a particular distance between the connectingdevices 2920, each of the plates 2902 includes a securing screw 2918(a,b), respectively. This arrangement is similar to the one shown in FIGS.12-27. In some embodiments, a portion of the part 2910 is configured tofit inside an interior of at least a portion of the part 2912 and allowfor a translational movement of the parts 2910 and 2912 with respect toeach other, as shown in FIG. 29. Upon translating the parts to a desireddistance, a rotational force is applied to the screw 2918 to secure suchdistance. Each of the plates 2902 include interior and exteriorportions. The interior portions are configured to be placed adjacent tothe bone and face each other when the device 2900 is attached to thebone. The interior portions further include protrusions 2922 that areconfigured to prevent slippage of the plates 2902 when the latter areattached to the bone.

In some embodiments, portions 2910 and 2912 include flange portions2927(a, b), as shown in the plate 2902 b, wherein the flange portions2927 are disposed adjacent the bottom parts of portions 2910 b and 2912b of the plate 2902 b. As can be understood by one skilled in the art,the flange portions 2927 can be configured to be disposed on any or allportions of the plates 2902. The flange portions 2927 are configured toform an angular arrangement with the surfaces of the portions 2910 and2912, as shown in FIG. 29. Such angular arrangement allows the plates2902 to firmly grip, hug or otherwise attach to the spinous process'stronger portions, thereby providing additional support to the spinousprocess plate clamp 2900 when it is secured to the spinous process. Theflange portions 2927 can be configured to create additional friction andthus prevent sliding of the plate clamp. In some embodiments, the innersides of the flange portions 2927 can be configured to includeprotrusions 2922 (similar to the inner sides of the parts 2910 and2912), thereby creating further support to the plate clamp 2900. FIGS.30 a-30 c are perspective views of the plate clamp 2900 being attachedto spinous process 3010. As can be understood by one skilled in the art,the flange portion 2927 can be configured to form any predeterminedangle with the appropriate parts of plates 2902. Such angles can varyfrom part to part and can be determined by the surgeon (or any othermedical professional).

As in the embodiments discussed in connection with FIGS. 12-27 above,the part 2910 includes an opening 2981 for insertion of the screw 2920,and a plurality of protrusions 2922 disposed on an interior portion ofthe part 2910. The part 2910 also includes a hollow interior 2983 thatis configured to accommodate placement of an extended portion 2921 ofthe part 2912. The part 2910 also includes an opening 2914 configured toaccommodate insertion of the screw 2918 for securing the parts 2910 and2912 together. In some embodiments, the interior portion 2983 caninclude rail(s) that are configured to mate with corresponding rail(s)of the extended portion 2921 of the part 2912 to allow for smoothersliding of the extended portion 2921 inside the interior portion 2983.The part 2910 further includes a slot 2985 that is configured toaccommodate insertion of a locking clip 2919. The slot 2985 isconfigured to include locking flanges for interlocking the locking clip2919. The locking clip 2919 is configured to provide additional securityto the screw 2918.

FIG. 31 illustrates yet another exemplary spinous process clamp device3102, for fixedly coupling adjacent spinous processes, according to someembodiments of the present invention. The device 3102 is configured toincorporate some of the features of the devices described above withregard to FIGS. 1-30 c. The spinous process clamp includes a first plate3104 and a second plate 3106 angularly, rotationally, and translatinglycoupled together and configured to abut the opposing bony mattersurfaces of adjacent spinous processes. The first plate 3104 and thesecond plate 3106 share a common longitudinal axis 3128 when in anominal position. A nominal position may be established by both slidingplates being arranged parallel and adjacent to each other in an elongatelongitudinal orientation, prior to conforming to a patient user'sspinous process geometry. The longitudinal axis 3128 is substantiallyparallel with the vertebral axis in the superior-inferior direction ofthe spine, and substantially located on a plane extending from amedial-lateral anterior location of the spine to a medial-lateralposterior location of the spine. The anterior-posterior plane containingthe longitudinal axis 3128 generally aligns with the sagittal plane ofthe human body.

Referring to FIG. 31, the first plate 3104 includes a first sliding part3108, a second sliding part 3110, and a securing mechanism or firstsecuring screw 3122, where the first sliding part 3108 is coupled to thesecond sliding part 3110 and the first securing screw 3122 engages boththe first sliding part 3108 and the second sliding part 3110.

Referring to FIGS. 31 thru 33 a-b, the first sliding part 3108 includesan interior portion 3208 which may have a flat surface configured toabut against one side of a first spinous process, an exterior portion3206, at least one and a plurality of protrusions 3220 on the interiorportion 3208, a pocket 3120, a rod 3204, a first extended portion 3116,at least one ridge 3202, a first flange portion 3214, and a first pivotaxis 3314.

In some embodiments, referring again to FIGS. 33 a-b, the first slidingpart 3108 is configured in a generally rectangular or polygonal shape,elongated along the longitudinal axis 3128, or in the superior-inferiordirection. The first sliding part 3108 further includes four peripheralsurfaces, a first anterior face 3302, a first posterior face 3304, afirst coupling face 3308, and a first end face 3306.

In some embodiments, the first anterior face 3302 establishes thefurthest-most anterior surface of the first sliding part 3108 relativeto the insertion orientation on the spinous processes. In a similarfashion, the first posterior face 3304 establishes the furthest-mostposterior surface. The first end face 3306 establishes a length-wise endsurface of the first sliding part 3108 and the first plate 3104 when thefirst and second sliding parts 3108, 3110 are coupled together, and maybe considered a lower end of the first sliding part 3108 and first plate3104. The first coupling face 3308 establishes the length-wise endsurface of the first sliding part 3108, and may be considered the upperend of the first sliding part 3108. The opposing peripheral faces 3302,3304 and 3306, 3308 are generally parallel to each other; however theangular relationship of the opposing faces may vary as dictated byinsertion application requirements.

In some embodiments, the interior portion 3208 and the exterior portion3206 are substantially parallel and substantially flat, however surfacegeometry may alternatively vary to accommodate further capabilities inthe insertion, assembly, location and orientation of the spinous processclamp to a variety of abutting spinous process surfaces, e.g., a surfaceor cross-section that is curved, wavy, sinusoidal, stepped, angled,thick, thin, or the like. In some embodiments, for example, the firstflange 3214 is not flat on the interior and/or exterior portions 3208,3206. The interior and exterior portions establish the thickness of thefirst sliding part 3108. The interior portion 3208 is configured to beplaced adjacent the bone and face each other when the device 3102 isattached to the bone.

In some embodiments, the interior portion 3208 of the first sliding part3108 is substantially parallel to the longitudinal axis of the spinousprocess clamping device when in a nominal position prior to altering thefirst plate 3104 angular relationship to accommodate spinous processesgeometries. The nominal position may subsequently be varied during thecourse of insertion and abutment to the spinous processes as an intendedclamping device feature to accommodate varying geometry of the spinousprocesses, the application needs of the user, and the surgeon's desiredapproach to fixation.

The interior portion 3208 of the first sliding part 3108 is configuredto include at least one protrusion 3220 coupled to a first bony mattercontacting area 3310 of the interior portion 3208 of the first slidingpart 3108. The first bony matter contacting area 3310 is configured todirectly interact and engage the spinous process. The protrusions 3220advantageously provide increased frictional contact with bony matter ofthe spinous processes, mitigating movement by preventing slippage of thefirst sliding part 3108, the first plate 3104, and the spinous processclamping device relative the spinous process, as well as promoting bonegrowth attachment to the clamping device, after being securedly abuttedto adjacent spinous processes. The protrusion may be configured similarto the protrusions of the above devices shown in FIGS. 1-30 c. Theprotrusions size and shape may vary depending on the desired applicationof the spinous process clamp, e.g., height, effective diameter, or thelike, and shapes such as pyramidal, cylindrical, conical,frusto-conical, or the like. The variations of size and shapeaccommodate the specific geometry of the spinous process of the patientuser or a desired mechanical interface to the spinous processes.

In some embodiments, referring further to FIGS. 33 a-b, the firstsliding part 3108 further includes a first extended portion 3116extending in a direction along the longitudinal axis away from the firstend face 3306 in the superior direction, or alternatively the inferiordirection depending on the interchangeable insertion orientation of theclamping device itself, i.e., which end is up as determined by insertionorientation in the body. The first extended portion 3116 furtherincludes a first extended anterior face 3318 and a first extendedposterior face 3320, which combine with the first coupling face 3306 toestablish the peripheral surfaces of the first extended portion 3116.The first extended portion 3116 may have a rectangular plate-likeconfiguration, and include the first pivot axis 3314 that is generallyparallel to the elongate longitudinal axis of the clamping device, butmay be varied as necessary. The first extended portion 3116 also has atleast one ridge 3202 located on the first extended posterior face 3320,generally containing a plurality of ridges 3202, to provide foradjustability during coupling of the first sliding plate to the secondsliding plate as described further below.

In some embodiments, the first extended portion 3116 of the firstsliding part 3108 may be configured to include a different surfacegeometry and medial-lateral cross-section than the interior portion 3208and the first bony matter contacting area 3310. By way of example, thecross-section geometry of the first extended portion 3116 may be in theshape of a rectangle, a diamond, or a similar polygonal, orcircular/rounded shape, or the like. The first extended portion 3116 mayhave a smaller cross-section than the first bony matter contacting area3310 portion of the first sliding part 3108 to allow for an insertioncoupling into the second sliding part 3110.

In some embodiments, the first sliding part 3108 and the second slidingpart 3110 are configured to allow relative motion, rotation or twist,between the two sliding parts about the rotation of axis established onthe first sliding part 3108. The first extended portion 3116 may beconfigured to include the first pivot axis 3314 about which a firstpivot surface 3316 is located on the opposing exterior and interiorportion surfaces 3206, 3208 of the first extended portion 3116. Thefirst pivot surface 3316 includes geometric features, which may be flat,protrude outward, or be recessed inward, and creating contact/pivotsurfaces with the coupling surface of the second sliding part 3110. Thegeometry of the first pivot surface 3316 may create a discontinuoussurface, or shape, on the first extended portion 3116 of the firstsliding part 3108, e.g. a semi-cylinder, triangle, rectangle, polygon,or the like. In the embodiment illustrated, the first pivot surface 3316includes a rounded protrusion extending longitudinally along the firstextended portion 3116, provided on both interior and exterior sides ofthe extended portion 3116, and substantially centered between the firstextended anterior and posterior faces 3318, 3320. The rotation or twistcapability advantageously allows the two parts 3108, 3110, or ends, ofthe first plate 3104 to independently conform to the geometry of theengaged spinous process bony matter.

In some embodiments, the first pivot surface 3316 is proximately locatedat the anterior-posterior midpoint of the first extended portion 3116,between the first extended anterior face 3318 and the first extendedposterior face 3320, and extending along at least a portion of thelongitudinal direction of the first extended portion 3116.Alternatively, the first pivot surface 3316 may be located anywherebetween the first extended anterior face 3318 and the first extendedposterior face 3320 and extend in any direction.

In some embodiments, referring again to FIGS. 33 a-b, the pocket 3120includes a recess 3312 in the interior portion 3208 of the first slidingpart 3108. The recess 3312 extends transversely to the longitudinal axisof the first sliding part 3108, from the first posterior face 3304 to adistance from the first posterior face 3304. Alternatively, the recess3312 may be located, beginning and ending, anywhere within theanterior-posterior width of the first sliding plate. The pocket 3120establishes an open space or recess on the interior portion 3208configured to receive a portion of the second plate 3106, describedbelow. The pocket 3120 is longitudinally located between the first bonymatter contacting area 3310 and the first extended portion 3116 of thefirst sliding plate. The pocket 3120 is further configured to be locatedbetween the adjacent spinous processes, allowing the first plate 3104and the second plate 3106 to couple between the spinous processeswithout altering the spinous processes.

The surface of the pocket 3120 is recessed below the surface of the bonymatter contacting area 3310 of the first sliding plate and may furtherrecess in an exterior direction beyond the exterior portion 3206 face ofthe first sliding part 3108. The pocket 3120 may protrude in anexteriorly outward direction to allow the recess 3312 surface to berecessed below both of the planar surfaces of the interior and exteriorportions 3208, 3206. Thus, the interior portion 3208 of the pocket 3120is located a distance between the interior portion 3208 and exteriorportion 3206 of the first sliding plate. The longitudinal cross-sectionof the pocket 3120, transverse to the direction of the pocket 3120extension, is shaped according to the needs of the user and/or theconfiguration of the second plate 3106, e.g., a cylinder, a sphere, apolygon, or the like.

In some embodiments, the rod 3204 is fixedly coupled to the interiorportion 3208 of the first sliding part 3108 and extends from theinterior portion 3208 in a transverse, or orthogonal, direction to theface of the interior portion 3208, and transverse to the longitudinalaxis of the first sliding plate. The rod 3204, as illustrated, may alsobe coupled to the first sliding plate at the pocket 3120. The rod 3204coupling is located within the thickness of the first sliding part 3108at the recessed surface of the pocket 3120. The rod 3204 extends adistance sufficient to interact with the second plate 3106 as describedbelow. The rod 3204 length is established by the geometry of the spinousprocesses and the needs of the patient user.

The rod 3204 as illustrated is longitudinally located substantially inthe center of the pocket 3120. In the anterior-posterior direction, therod 3204 location is a distance from the first posterior face 3304 ofthe first sliding plate, and is configured to couple to the couplingmeans of the second plate 3106 as described below. The rod 3204 islocated anterior to the coupling element, or arm 3126, of the secondplate 3106. Additionally, the rod 3204 is configured to be locatedbetween the adjacent spinous processes.

In some embodiments, the ridges 3202 are located on the first extendedposterior face 3320 of the first extended portion 3116 of the firstsliding part 3108. The ridges 3202 form a discontinuous surface on thefirst posterior face. The discontinuous, or non-flat, geometric featurescan be of varying shapes e.g., polygon-shaped steps, curves, sinusoidal,triangular, or the like. The shape of the ridges 3202 extend transverse,or orthogonal, to the longitudinal axis of the first sliding plate andsubstantially orthogonal to the exterior portion 3206 and the interiorportion 3208. Alternatively, the direction and shape of thediscontinuous ridges 3202 can be in any desired orientation or shape.The discontinuous surface extends along the full thickness of the firstextended portion 3116 between the interior and exterior portions 3208,3206, or alternatively, along a sufficient portion to engage thesecuring screw 3122 as discussed below.

The ridges' 3202 surface geometry discontinuity provides a frictioninducing or locking location to establish a securing force by means ofthe securing screw 3122 when the spinous process clamping device isassembled. Assembly for the ridges 3202 occurs when the first slidingpart 3108, the second sliding part 3110, and the securing screw 3122 arecoupled together to form the first plate 3104.

In some embodiments, the first flange portion 3214 is located adjacentthe anterior portion of the first sliding part 3108 and extendsoutwardly from the vertebral center, the longitudinal axis of thespinous process clamping device, and the exterior portion 3206 in anexterior direction. The first flange portion 3214 surface may be roundedaround the peripheral surfaces of the first sliding part 3108. Theradial degree of rounding at the corners and the edges, and the angulardegree of the first flange portion 3214 trajectory away from thelongitudinal axis or the interior portion 3208, can be varied. The firstflange portion 3214 shape provides for a secure abutment to the spinousprocesses, and accommodates a variety of patient user spinous processgeometries. The first flange portion 3214 geometry is one optionalsurface feature that makes the interior and exterior portions 3208, 3206of the first sliding plate non-flat.

In some embodiments, illustrated in FIGS. 37 a-b, the first securingscrew 3122 may include a threaded cylinder, or a functional equivalent,that establishes the desired longitudinal length of the first plate 3104by locking the coupled relationship between the first sliding part 3108and the second sliding part 3110. The first securing screw 3122 has anendpoint projection 3706 that engages the geometric features of theridges 3202 and prevents the first extended portion 3116 of the firstsliding part 3108 from de-coupling from the second sliding part 3110.The first securing screw 3122 additionally has a recess 3702 configuredto accommodate wrenches as described for screw 110 above, to allowinstallation into the first opening 3210 by rotatingly engaging thethreads 3704 of the screw with threads in the opening 3210.Alternatively, other fastening mechanisms known in the art may be usedto secure the two sliding parts. The longitudinal length of the firstextended portion 3116, and the location of the ridges 3202, may varyaccording to the patient user needs to establish the overall length ofthe first plate 3104.

Referring to FIGS. 34 a-b, in some embodiments the second sliding part3110 includes an interior portion 3208, an exterior portion 3206, afirst hollow interior 3402, a second pivot axis 3412, a second pivotsurface 3414, a second flange portion 3216, at least one protrusion3220, a second bony matter contacting area 3416, a second anterior face3404, a second coupling face 3410, a second end face 3408, and a secondposterior face 3406. Like named elements include similar characteristicsas the first sliding part 3108, and details with respect to such secondsliding part 3110 elements are referred to the description of the firstsliding part 3108.

In some embodiments, the interior portion 3208, the exterior portion3206, the peripheral faces 3404, 3406, 3408, 3410, the second bonymatter contacting area 3416, and the protrusions 3220 may have the samecharacteristics as the first sliding part 3108. However, the entireinterior portion 3208 of the second sliding part 3110 includessubstantially of the second bony matter contacting area 3416 andconfigured to abut a second adjacent spinous process. Additionally, thesecond coupling face 3410 of the second sliding part 3110 includes anaperture opening to the first hollow interior 3402.

The parallel relationship between the interior portion 3208 and theexterior portion 3206 of the second sliding part 3110 may be modified toaccommodate a patient user's needs upon insertion. Therefore, the twosurfaces can have a substantially angled or varying relationship betweenthe exterior and interior portion 3208 s. Accordingly, the exterior andinterior parallel relationship can also be modified on the first slidingpart 3108.

Generally the relationship between the interior portion 3208 and theexterior portion 3206 of both the first sliding part 3108 and the secondsliding part 3110 may be similar. However, the relationship between thetwo surfaces may differ between the first sliding part 3108 and thesecond sliding part 3110 as required to accommodate insertion into thepatient user.

In some embodiments, the second coupling face 3410 is configured toreceive the first extended portion 3116 of the first sliding part 3108.The second end face 3408 of the second sliding part 3110 is configuredto be opposite the first end face 3306 of the first sliding part 3108and may be considered the upper end of first plate 3104. The first endface 3306 of the first sliding part 3108 and the second end face 3408 ofthe second sliding part 3110 establish the outermost longitudinal endsof the first plate 3104 when the first sliding part 3108 and the secondsliding part 3110 are coupled together. Thus, they establish the overalllength of the first plate 3104.

In some embodiments, the first hollow interior 3402 of the secondsliding part 3110 is configured to receive the first extended portion3116 of the first sliding part 3108. The first hollow interior 3402includes a second pivot axis 3412 that generally is in the elongatedirection and parallel to the longitudinal axis of the spinous processclamping device. However, the second pivot axis 3412 may vary in amanner similar to the first pivot axis 3314 of the first sliding part3108. The first hollow interior 3402 further includes the second pivotsurface 3414 about the second pivot axis 3412 configured to receive thefirst pivot surface 3316 of the first extended portion 3116 of the firstsliding part 3108. Pivot surface 3414 may be rounded or similarly shapedto mate with pivot surface 3316. The two pivot surfaces 3316, 3414interact when the first sliding part 3108 is coupled to the secondsliding part 3110 to allow the first sliding part 3108 and the secondsliding part 3110 to rotate, or twist with respect to each other, aboutthe substantially co-linear pivot axes 3314, 3412 of the two slidingparts. The rotation, or twist, is accommodated by the configuring of thefirst hollow interior 3402 and the first extended portion 3116, allowingthe first extended portion 3116 to rotate about the pivot surfaceswithin the first hollow interior 3402. As illustrated, the first hollowinterior 3402 may be configured to define a bow-tie shape opening, whichwidens from its center toward the posterior and anterior ends, toaccommodate rotation of the first extended portion 3116 in first hollowinterior 3402 about the pivot surfaces 3316, 3414.

In some embodiments, the first opening 3210 of the second sliding part3110 is located on the second posterior face 3406 of the second slidingpart 3110. The first opening 3210 is threaded and configured to receivethe first securing screw 3122. The first opening 3210 is furtherconfigured to allow the first securing screw 3122 engaging end 3706 tofurther engage at least one ridge 3202 of the first extended portion3116, where the first extended portion 3116 is inserted in first hollowinterior 3402. The first opening 3210 location allows access to insertthe securing screw 3122, or to secure the securing mechanism, subsequentto insertion of clamping device 3102 into the patient user.Alternatively, the securing screw 3122 may also be secured to the firstand second sliding parts 3108, 3110 prior to insertion into the patientuser. The opening 3210 is advantageously oriented to provide directposterior access, as opposed to lateral access, to adjust the firstplate 3104 length.

Securing the securing screw 3122 into the first opening 3210 andengaging the ridge 3202 of the first extended portion 3116 establishes alongitudinal relationship between the first sliding part 3108 and thesecond sliding part 3110 and determines the overall length of the firstplate 3104. A plurality of ridges 3202 on the first extended portion3116 provides adjustability to the overall length of the first plate3104. The securing screw 3122 may selectively engage a ridge 3202 on thefirst extended portion 3116 that will most beneficially enable insertionof the spinous process clamping device onto the adjacent spinousprocesses and into the patient user.

Similarly, referring to FIGS. 31 and 32, the second plate 3106 includesa third sliding part 3112, a fourth sliding part 3114, and a secondsecuring screw 3124, where the third sliding part 3112 is coupled to thefourth sliding part 3114 and the second securing screw 3124 engages boththe third sliding part 3112 at a second opening 3212, and the fourthsliding part 3114.

In some embodiments, referring to FIGS. 31, 32 and 35 a-b, the thirdsliding part 3112 includes an interior portion 3208, an exterior portion3206, a second extended portion 3118, a third pivot axis 3514, a thirdpivot surface 3516, at least one ridge 3202, a third flange portion3522, at least one protrusion 3220, a third bony matter contacting area3510, an arm 3126, an aperture 3518, a third anterior face 3502, a thirdcoupling face 3508, a third end face 3506, and a third posterior face3504. The second extended portion 3118 further includes a secondextended anterior face 3524 and a second extended posterior face 3526,which combine with the third coupling face 3508 to establish theperipheral surfaces of the second extended portion 3118.

Like named elements include similar characteristics as the first plate3104 and the first sliding part 3108, and are generally symmetric aboutthe longitudinal axis of the spinous process clamping device. Detailswith respect to common third sliding part 3112 elements are referred tothe description of the first sliding part 3108. The elementaldifferences between the first sliding part 3108 and the third slidingpart 3112 include the aperture 3518 and the arm 3126, and the lack of arod 3204 and a pocket 3120 on the third sliding part 3112. The commonelements of the first sliding part 3108 and the third sliding part 3112are not required to be symmetric about the longitudinal axis of theclamp; each may vary independently within the scope of the disclosure.

In some embodiments, referring again to FIGS. 35 a-b, the arm 3126 ofthe third sliding part 3112 is coupled to the interior portion 3208 andis located adjacent to, and may be a part of, the third posterior face3504. The arm 3126 extends transversely, or orthogonal to, thelongitudinal axis of the clamp device and extends away from the interiorportion 3208 of the third sliding part 3112. The arm 3126 extends in thesame general direction as the protrusions 3220, away from the third bonymatter contacting area 3510. The arm 3126 further has a third opening3520 at the outward-most end of the arm 3126, the end that extends awayfrom the interior portion 3208 of the third sliding part 3112.

The arm 3126 is generally a polygonal shape, although the shape can beconfigured in any shape deemed appropriate for insertion into thepatient user and abutment to adjacent spinous processes. The arm 3126has an anterior surface and a posterior surface. The third opening 3520extends in an anterior-posterior direction, transverse to thelongitudinal axis, creating a through-hole between the anterior andposterior surfaces of the arm 3126. The through-hole is configured toreceive a clevis 3218 described further below.

In some embodiments, the aperture 3518 is rectangular in shape, and hasan elongate direction generally parallel to the longitudinal axis of thethird sliding part 3112. The aperture 3518 has a generally polygonalshape, however the aperture 3518 can take the shape of a curved,circular, oval, or non-polygon shape as determined most appropriate forfunction, costs of manufacturability, or any other variable deemedapplicable. The polygonal shape generally has a shorter length in theanterior-posterior axis and a longer elongate length in thesuperior-inferior direction, or the longitudinal direction of theclamping device.

The aperture 3518 is located adjacent to the anterior side of the arm3126, spaced a distance from the third posterior face 3504 of the thirdsliding part 3112. The aperture 3518 extends transversely through thethickness of the third sliding part 3112, extending from the exteriorportion 3206 through to the anterior surface of the third sliding part3112. The aperture 3518 is configured to receive, if necessary, the rod3204 of the first sliding part 3108 upon assembly and insertion of thefirst plate 3104 and the second plate 3106 of the spinous processclamping device.

The features and characteristics of the third sliding part 3112 are notnecessarily required to be the same as that of the first sliding part3108. Variations may exist between the geometries, features, and othercommon characteristics of both the first sliding part 3108 and the thirdsliding part 3112 as may be necessary to accommodate orientation forinsertion at the geometric surfaces of the spinous processes of thepatient user.

In some embodiments, referring to FIGS. 36 a-b, the fourth sliding part3114 includes the same elements, and disclosed variations to thoseelements, as the second sliding part 3110. The fourth sliding part 3114includes an interior portion 3208, an exterior portion 3206, a secondopening 3212, a second hollow interior 3604, a fourth pivot axis 3614, afourth pivot surface 3616, a fourth flange portion 3602, at least oneprotrusion 3220, a fourth bony matter contacting area 3618, a fourthanterior face 3606, a fourth coupling face 3612, a fourth end face 3610,and a fourth posterior face 3608. Like named elements include similarcharacteristics as the second sliding part 3110, and details withrespect to these fourth sliding part 3114 elements are referred to thedescription of the second sliding part 3110.

The third sliding part 3112 and the fourth sliding part 3114 may becoupled together and provide an ability to rotate, or twist, relative toeach part, in a manner similar to the first sliding part 3108 and thesecond sliding part 3110.

In some embodiments, the spinous process clamping device furtherincludes the clevis 3218. Referring to FIG. 38, the clevis 3218 includesa rounded, curved, or spherical head 3802, an aperture 3810 through-holein the head, a shank 3804, and external threads 3806 on a threadedportion of the shank. The clevis 3218 includes a nut 3902, referring toFIG. 39, having internal threads 3904, to engagingly secure on thethreaded portion of the shank 3804. The through-hole aperture 3810 has acenterline axis extending through the head of the clevis 3218, and theclevis 3218 aperture 3810 through-hole is configured to receive the rod3204. The shank has a longitudinal axis 3808 that extends away from thehead 3802 in a transverse, or orthogonal, direction to the aperture 3810through-hole centerline axis. The aperture 3810 through-hole diameterextends further toward the clevis 3218 shank than a flat 3812 of theclevis 3218 head 3802, where the flat 3812 of the head 3802 issubstantially orthogonal to the shank longitudinal axis. The clevis 3218is coupled to the nut 3902 by threading the nut onto the threaded shank.

The spinous process clamping device is coupled together via the clevis3218 and the arm 3126 of the second plate 3106 and the rod 3204 of thefirst plate 3104. The clevis 3218 engages the arm 3126 by inserting theclevis 3218 shank 3804 through the third opening 3520 on the arm 3126.The clevis 3218 shank 3804 longitudinal axis 3808 is transverse to thelongitudinal axis 3128 of the spinous process clamp device. The nut 3902is then engaged with the threads 3806 on the shank 3804 to secure theclevis 3218 to the arm 3126 of the second plate 3106, or the thirdsliding part 3112. The clevis 3218 and second plate 3106 is then securedto the first plate 3104 by aligning the clevis 3218 aperture 3810though-hole centerline axis with the rod 3204 length-wise axis such thatthe clevis 3218 receives the rod 3204. The nut 3902 coupling to theclevis 3218 is advantageously located directly posterior to theinsertion direction, allowing direct access to the nut 3902 forinsertion adjustment and securing of the two plates 3104, 3106.

Securing of the two plates 3104, 3106 occurs by way of rotating the nut3902 such that the internal threads 3904 of the nut 3902 securinglyengage the external threads 3806 of the clevis 3218. The arm 3126 androd 3204 are tightly secured by means of the flat 3812 on the clevis3218 being located on a plane projecting through/within the aperture3810. This means the aperture 3810 extends further on the longitudinalaxis 3808 toward the threaded end than the flat 3812. Thus, as the nut3902 engages clevis 3218 and draws the clevis head 3802 toward arm 3126,the rod 3204 contacts arm 3126 before flat 3812. The rod 3204 contactestablishes a physical stop for the clevis 3218 and further engagingrotation of nut 3902 creates a tight securing between arm 3126 and rod3204 via the clevis 3218 and nut 3902, while flat 3812 does not contactarm 3126.

Prior to securing of the nut 3902, the clevis 3218 can advantageouslytranslate along the length of the rod 3204. The gap, or spaced distance,between the first plate 3104 and the second plate 3106, is varied by thetranslation of the clevis 3218 on the rod 3204. The gap is modified uponinsertion to allow the first and the second plates 3104, 3106 to abutthe adjacent spinous processes, which provides for installation onvarying thicknesses of spinous processes. The non-incrementaltranslation allows for infinite adjustability between the two plates3104, 3106. The dynamic coupling of the rod allows compression anddistraction without interference with the adjacent spinous structures oranatomy. Additionally, the clevis 3218 can rotate about the shanklongitudinal axis 3808 inserted through the arm 3126 third opening 3520.The clevis 3218 rotation allows the first plate 3104 and the secondplate 3106 to rotate with respect to each other about the clevis 3218shank 3804 longitudinal axis 3808. The rotation capability furtherallows the spinous process clamping device to adjust to the particulargeometry of the patient user's spinous processes.

The configuration of the rod 3204 may advantageously vary in length toaccommodate a wide variety of thicknesses of the adjacent spinousprocesses. The rod 3204 may be longer than the lateral thickness of thespinous processes, in which case the end of the rod 3204 projectingthrough the clevis aperture 3810 may also extend through the aperture3518 of third sliding part 3112. Additionally, the first and secondplates 3104, 3106 can contact at their interior portions 3208, tominimize overall size of clamping device 3102 during insertion, asdesired. The elongate shape of aperture 3518 provides for longitudinalmovement of the rod 3204 within aperture 3518, which may be desired whenthe first and second plates rotate with respect to each other aboutclevis 3218. Thus, the elongate aperture 3518 provides a wide range ofrotation between the two plates, further providing ease of insertion,assembly and abutment of the spinous process clamping device 3102 in thepatient user.

The spinous process clamping device can advantageously adjust byrotation of the two plates 3104, 3106 with respect to each plate about avariably selected pivot axis established by the clevis 3218 location,and by rotation, or twist of each sliding part 3108, 3110, 3112, 3114 ofthe two plates 3104, 3106 about the common pivot axis of the extendedportions 3116, 3118 and the hollow interiors 3402, 3604. Thus, thespinous process clamping device 3102 provides for an angularly,rotatingly, and translatingly capable coupling between the two plates3104, 3106, as well as independent rotation or twist between theindividual parts or members 3108, 3110, 3112, 3114, of each plate 3104,3106.

The spinous process clamp device 3102 is assembled, inserted, andabutted against adjacent spinous processes of the patient user tofixedly establish the spaced distance between the adjacent spinousprocesses. The clamp device 3102 may be inserted in either an assembledor disassembled configuration as dictated by specific needs and geometryof the patient user. A single incision may be made adjacent onemedial-lateral side of the adjacent spinous processes, multipleincisions may be made adjacent both medial-lateral sides of the adjacentspinous processes, or a single incision in the medial-lateral center ofthe vertebrae may be made, to provide access for insertion of the clampdevice 3102. The clamp may be assembled in whole or in part eitherbefore or after insertion into the patient user.

The clamp may be assembled as described above with the interior portions3208 of both plates 3104, 3106 contacting each other, the nut 3902tightly securing the arm 3126 and rod 3204, and set screws 3122, 3124securingly engaged with the ridges 3202 to lock the longitudinal lengthof both plates 3104, 3106 to create a small minimized geometricinsertion cross section for the assembly. The plates 3104, 3106longitudinal length may be locked at the shortest length to minimizeinsertion geometry, or alternatively may be locked at a pre-establisheddesirable length to fix the adjacent spinous processes.

After inserting the assembled clamp device 3102 in the patient useradjacent the spinous processes, the nut 3902 may be loosened to allowspaced distance between the plates 3104, 3106 and orient the plates onopposing medial-lateral surfaces of the spinous processes. The rotationcapability between the plates 3104, 3106 assists in orienting the platesinto proper configuration to abut the opposing surfaces of the spinousprocesses.

The rotation, or twist, capability between the two parts of each plate3104, 3106 provides for abutment to the complex geometry of the adjacentspinous processes. The bony matter contacting surfaces 3310, 3416, 3510,3618 may be externally forced adjacent the spinous processes, oralternatively, may be allowed to settle into a natural fit positionadjacent the spinous processes. The twist capability between the partsand the rotation and translation adjustment between the plates providesfor a secure abutment and fixation of the adjacent spinous processes byclamping device 3102.

Accordingly, the length of the plates 3104, 3106 may be established, ifnot established prior to insertion, by looseningly rotating the setscrews 3122, 3124 and extending the plates from the shortest lengthwiseconfiguration to the required length. The length is lockinglyestablished by tighteningly rotating the set screws 3122, 3124 to engageridges 3202. The length of plates 3104, 3106 may be established eitherbefore or after the inserted plates are configured on opposing surfacesof the spinous processes, however, greater ease of orientation andabutment of clamp device 3102 exists when the plates are configured in areduced geometric size corresponding to the shortest length of theplates 3104, 3106.

FIG. 40 illustrates yet another exemplary spinous process clamp device4002, for fixedly coupling adjacent spinous processes, according to someembodiments of the present invention. The clamp device 4002 isconfigured to incorporate some of the features of the devices describedabove with regard to FIGS. 1-39. In particular, like named elementsinclude the same or similar characteristics as described above for theembodiment of clamp device 3102. Details with respect to common elementsare referred to the description of clamp device 3102. New elements ofthe spinous process clamp device 4002 are described below.

In some embodiments, referring to FIG. 40, the spinous process clamp4002 includes a first plate 4004 and a second plate 4006 angularly,rotationally, and translatingly coupled together and configured to abutthe opposing bony matter surfaces of adjacent spinous processes.

In some embodiments, referring to FIGS. 41 and 42 a-42 b, first plate4004 includes a first sliding part 4008. First sliding part 4008 may berotationally and translationally coupled to the second sliding part 3110as described above with respect to device 3102 and generally has thesame characteristics as first sliding part 3108 except for thedifferences associated with the coupling mechanism between the firstplate 4004 and the second plate 4006 described further below.

First sliding part 4008 further includes a first recess 4012, a firstarm 4102, and a second hole 4114. First recess 4012 is located oninterior portion 3208, generally adjacent to the first extended portion3116 of first sliding part 4008. First recess 4012 establishes a surfacebelow interior portion 3208 in the direction of an exterior portion3206. The first recess 4012 generally extends in an elongate directionnormal to the longitudinal axis 3128 of the clamp device 4002. The firstrecess 4012 may extend from the first posterior face 3304 in theelongate direction through to the first anterior face 3302 of firstsliding part 4008, spanning the full anterior-posterior width of firstsliding part 4008. Alternatively the first recess 4012 may extend up tothe first arm 4102. First recess 4012 as illustrated may have ageometric shape of a cylinder, however other geometric shapes arepossible, e.g. a polygon, a triangle, an oval, or the like.

First arm 4102 extends away from the interior portion 3208 of firstsliding part 4008 in a direction substantially normal to the generallyflat surface of interior portion 3208 toward the second plate 4006. Thecross section of the first arm 4102 may have a rectangular shape,although other geometric shapes are possible. The elongate direction ofthe rectangular cross section is parallel to the longitudinal axis ofthe clamp 4002. First arm 4102 includes a top face 4204, a bottom face4206, and a lip 4202. Top face 4204 is generally flat and may beparallel to the longitudinal axis 3128 of clamp device 4002 and also isparallel to the first posterior face 3304. Bottom face 4206 issubstantially parallel to top face 4204. The lip 4202 is a portion ofthe arm 4102 located on the bottom face 4206 adjacent the end farthestmost away from the interior portion 3208 that protrudes in an anteriordirection away from the bottom face 4204. First arm 4102 is configuredto be received by a coupler 4016 described further below.

Second hole 4114 is located on the first posterior face 3304. Secondhole 4114 establishes a coupling location for use in conjunction withinstruments, and advantageously provides direct access for instrumentsfrom the posterior direction to the clamp device 4002. Clamp 4002 mayinclude three additional and similar holes for use in conjunction withinstruments, a third hole 4116, a fourth hole 4118, and a fifth hole4120 as described below.

In some embodiments, referring to FIGS. 41 and 43, second plate 4006includes a third sliding part 4010 and a fourth sliding part 3114. Thirdsliding part 4010 may be rotationally and translationally coupled to thefourth sliding part 3114 as described above with respect to device 3102and generally has the same characteristics as third sliding part 3112except for the differences associated with the coupling mechanismbetween the first plate 4004 and the second plate 4006 described furtherbelow.

Third sliding part 4010 further includes a second recess 4014, a secondarm 4104, and the fourth hole 4118. Second recess 4014 is located oninterior portion 3208, generally adjacent to the second extended portion3118 of third sliding part 4010. Second recess 4014 establishes asurface below interior portion 3208 in the direction of an exteriorportion 3206. The second recess 4014 generally extends in an elongatedirection normal to the longitudinal axis 3128 of the clamp device 4002.The second recess 4014 may extend from the third posterior face 3504 inthe elongate direction through to the third anterior face 3502 of thirdsliding part 4010, spanning the full width of third sliding part 4010.Alternatively the second recess 4014 may extend up to the second arm4104. Second recess 4014 as illustrated may have a geometric shape of acylinder, however other geometric shapes are possible, e.g., a polygon,a triangle, an oval, or the like. Fourth hole 4118 is located on thethird posterior face 3504 and is used in conjunction with instruments.

Second arm 4104 extends away from the interior portion 3208 of thirdsliding part 4010 in a direction substantially normal to the generallyflat surface of interior portion 3208 toward the first plate 4004. Thecross section of the second arm 4104 may have a circular shape, althoughother geometric shapes are possible. Second arm 4104 further includesthreads 4302 and a sixth hole 4304. Sixth hole 4304 is adjacent thefarthest most end of second arm 4104 away from interior portion 3208.Sixth hole 4304 extends through the second arm 4104 from the anteriorface to the posterior face of the arm. The sixth hole 4304 is configuredto receive a third securing screw 4016 described further below, thusgenerally has a circular shape. The threads 4302 are located on theinner diameter of the generally circular shape of sixth hole 4304. Thethreads are configured to couple to the third securing screw 4016,described below with respect to FIG. 45.

In some embodiments, referring again to FIG. 41, the device 4002 furtherincludes a first hole 4108, a slot 4110, and a pin 4112. The first hole4108 is located on the bony matter abutting side of the second extendedportion 3118, more particularly on the third pivot surface 3516. Thefirst hole 4108 is configured to receive the pin 4112. The slot 4110 islocated on the interior portion 3208 of fourth sliding part 3114 andextends in an elongate direction parallel to the longitudinal axis ofclamp 4002. The slot 4110 is located parallel and opposite the fourthpivot surface 3616 such that the slot 4110 will align with the firsthole 4108 upon assembly of the second plate 4006. The pin 4112 isinserted, after assembly of second plate 4006, through the slot 4110 andsecuredly received into the first hole 4108. The pin 4112 establishesthe sliding translation range of the second extended portion 3118 withinsecond hollow interior 3604 as the pin 4112 contacts either end of theslot 4110 to establish translation maximums. Additionally, the samehole, pin, and slot configuration may be included on the first plate4004 (not shown/labeled). Even further, the same hole, pin, and slotconfiguration may be included on the first plate 3104 and the secondplate 3106 of the spinous process clamp device 3102 (not shown/labeled)described above.

The clamp 4002 may include four holes used in conjunction with insertioninstruments having the already described second hole 4114 and the fourthhole 4118, as well as third hole 4116 located on the second posteriorface 3406 of second sliding part 3110, and a fifth hole 4120 located onthe fourth posterior face 3608 of the fourth sliding part 3114. Thedescribed instrument holes may additionally be included in an embodimentof the spinous process clamp 3102.

FIG. 44 illustrates the coupler 4106. The coupler 4106 includes a body4402, a coupler thread 4404, a first coupler opening 4406, a secondcoupler opening 4408, a third coupler opening 4410, and a base 4412. Thebody 4402 establishes the peripheral shape of the coupler 4106. The body4402 generally is of cylindrical shape and is configured to receive thethird securing screw 4016, as well as the first arm 4102 and the secondarm 4104 described further below. The first coupler opening 4406 islocated on the farthest posterior end of the coupler 4106, creating anopen end of the cylinder shaped body 4402. The first coupler opening4406 is configured to receive the third securing screw 4016. The couplerthread 4404 may be similar to the typical internal fastener thread, andincludes at least a portion of one lead. The coupler thread 4404 islocated on the inner diameter established by the body 4402 and isadjacent the farthest posterior end of the coupler 4106 and adjacent thesecond coupler opening 4408.

The second coupler opening 4408 is located on the portion of the coupler4106 that is nearest to the first plate 4004 and adjacent the farthestanterior end of the coupler 4106, establishing an opening in thecylindrical periphery of the coupler 4106. The third coupler opening4410 is located on the portion of the coupler 4106 that is nearest tothe second plate 4006 and adjacent the farthest anterior end of thecoupler 4106, establishing an opening in the cylindrical periphery ofthe coupler 4106. As illustrated, the third coupler opening 4410 islarger than the second coupler opening 4408, however the second coupleropening 4408 may be smaller, larger, or the same size as the thirdcoupler opening 4410 as desired. The third coupler opening 4410 issubstantially parallel to the second coupler opening 4408 such that thetwo openings are on opposite sides of the coupler 4106.

The base 4412 establishes the end of the coupler 4106 that opposes thefirst coupler opening 4406, thus is located on the farthest anterior endof the coupler 4106. As illustrated, the base 4412 establishes a closedend of the cylinder, however other configurations are possible, e.g.slotted, holes, open, or the like. The base 4412 may have a straightside or edge such that the base 4412 does not establish a full circle.The straight side or edge is substantially parallel to the third opening4410 and is located on the portion of the coupler 4106 that is nearestto the second plate 4006.

FIG. 45 illustrates the third securing screw 4016. In some embodiments,the third securing screw 4016 can include a threaded cylinder, or afunctional equivalent, that establishes the desired distance, or gap, aswell as the angled relationship between the first plate 4004 and thesecond plate 4006 by locking the coupled relationship between the firstsliding part 4008 and the third sliding part 4010. The third securingscrew 4016 has a recess 4502 configured to accommodate wrenches asdescribed for screws 110 and 3122 above, to allow installation into thefirst coupler opening 4406 by rotatingly engaging the threads 4504 ofthe screw with the coupler thread 4404 in the first coupler opening4406. Alternatively, other fastening mechanisms known in the art may beused to secure the two angularly and translationally coupled plates4004, 4006.

The spinous process clamping device 4002 is coupled together via thecoupler 4106, the third securing screw 4016, the first arm 4102, and thesecond arm 4104. The coupler 4106 is configured to receive the otherthree elements. The first arm 4102 is received by the coupler 4106through the second coupler opening 4408 and is generally locatedadjacent and parallel to the base 4412 such that the bottom face 4206contacts the inner coupler 4106 surface of the base 4412. The first arm4102 is coupled to the coupler 4106 such that the lip 4202 of the firstarm 4102 is located at least beyond the straight edge of base 4412. Thelip 4202 mitigates the likelihood of the arm unexpectedly backing out ofthe coupler 4106 by creating a physical stop that will butt up againstthe straight edge 4414 and prevent further movement in the exiting, orbacking out, direction.

The second arm 4104 is received by the coupler 4106 through the thirdcoupler opening 4410 and is generally located posterior to the first arm4102. This arrangement establishes contact between the anterior side ofthe second arm 4104 and the top face 4204 of the first arm 4102. Thesecond arm 4104 is inserted to the coupler a distance sufficient toalign the center of the sixth hole 4304 of the second arm 4104 and thecenter of the first coupler opening 4406 of the coupler 4106. The thirdsecuring screw 4016 is received by first the coupler 4106 elements ofthe thread 4404 and by the first coupler opening 4406. The thirdsecuring screw 4016 is next received by internal threads 4302 of thehole 4304 of the second arm 4104. The third securing screw 4016 isreceived by rotatingly engaging the external threads 4504 with thecorresponding thread 4404 and threads 4302.

The spaced and angular relationship between the first plate 4004 and thesecond plate 4006, or the first sliding part 4008 and the third slidingpart 4010, are established by securingly rotating the third set screw4016 until tight. The anterior end of the third set screw 4016 willrotatingly engage coupler 4106 and the second arm 4104, bringing thesecond arm 4104 toward first coupler opening 4406 and then extendthrough the anterior end of sixth hole 4304 to contact the first arm4102 and snugly push the first arm 4102 against the base 4412.Sufficient force in rotation of third set screw 4016 will lock thetranslation of first arm 4102 through coupler 4106, which establishesthe spaced distance, or gap, between the first plate 4004 and the secondplate 4006. Sufficient rotation force will also lock the angularrotation, or relationship between the first plate 4004 and the secondplate 4006, about the substantially common center of the third set screw4016 and the coupler 4106 first opening 4406 and the sixth hole 4304 ofthe second arm 4104.

Rotation of the two plates about the substantially common center priorto tight rotation of the third set screw 4016 advantageously allows theclamp 4002 to vary the angular relationship of the two plates uponinsertion to the patient user and conform to the complex geometry of theadjacent spinous processes. The magnitude of angular rotation betweenthe first plate 4004 and the second plate 4006 is determined by therelative difference between the circumferential width of the secondcoupler opening 4408 and the longitudinal width of the first arm 4102,as well as the relative difference between the circumferential width ofthe third coupler opening 4410 and the longitudinal width of the secondarm 4104. The magnitude of the translation of first arm 4102 through thecoupler 4106 is determined by the depth of the second recess 4014 andthe longitudinal width of the first arm 4102.

Upon insertion into a patient user, the overall cross-sectionalfootprint of the assembled clamp, if assembled prior to insertion, maybe minimized by the first arm 4102 fully engaging the coupler 4106 bymaximum translation and allowing the end of the second arm 4104 to bereceived into the first recess 4012 such that the opposing bony mattercontacting surfaces of the first plate 4004 and the second plate 4006are as close together as possible.

Example embodiments of the methods and components of the presentinvention have been described herein. As noted elsewhere, these exampleembodiments have been described for illustrative purposes only, and arenot limiting. Other embodiments are possible and are covered by theinvention. Such embodiments will be apparent to persons skilled in therelevant art(s) based on the teachings contained herein. Thus, thebreadth and scope of the present invention should not be limited by anyof the above-described example embodiments, but should be defined onlyin accordance with the following claims and their equivalents.

1. A spinous process device, comprising: a first plate having a firstpart slidably coupled to a second part; a second plate having a thirdpart slidably coupled to a fourth part; and first and second connectordevices configured to be placed through openings created in spinousprocesses and rotatably couple respective first and second parts tothird and fourth parts of the first and second plates together allowingangular displacement of the second plate with respect to the first plateand secure the spinous processes between the first and second plates. 2.The device according to claim 1, further comprising first and secondlocking mechanisms configured to lock the first and second parts and thethird and fourth parts a desired distance apart.
 3. The device accordingto claim 1, wherein each plate includes an interior portion having aplurality of protrusions configured to interact with the bony matter. 4.The device according to claim 1, wherein upon connection of the firstand second plates using the first and second connector devices, thefirst and second plates are configured to be parallel to each other. 5.The device according to claim 1, wherein upon connection of the firstand second plates using the first and second connector devices, thefirst and second plates are configured to be disposed at an angle withrespect to each other.
 6. The device according to claim 1, wherein theconnector devices are selected from a group consisting of: screws,bolts, pins, springs, rods, and other suitable devices.
 7. The deviceaccording to claim 1, wherein each of the first, second, third andfourth parts includes an opening configured to accommodate the first andsecond connector devices.
 8. The device according to claim 1, wherein atleast one of the first, second, third and fourth parts includes anangularly disposed flange configured to form an angle with at least oneof the first, second, third and fourth parts.
 9. A spinous processdevice, comprising a first portion translationally coupled to a secondportion; first and second bone attachment mechanisms coupled to thefirst and second portions and configured to secure the first and secondportions to first and second spinous processes; a translationalmechanism configured to allow the first and second portions to translatewith respect to each other, varying the distance between the first andsecond bone attachment mechanisms; and a locking mechanism configured tolock the first and second portions at the desired distance between thefirst and second bone attachment mechanisms.
 10. The device according toclaim 9, wherein: the first bone attachment mechanism includes: a firstrod configured to be inserted into an opening created in the firstspinous process; and a clamping washer configured to couple with thefirst rod and secure the first portion to the first spinous process; andthe second bone attachment mechanism includes: a second rod configuredto be inserted into an opening created in the second spinous process;and a clamping washer configured to couple with the second rod andsecure the second portion to the second spinous process.
 11. The deviceaccording to claim 9, further comprising a plurality of protrusionsdisposed on the first and second portions configured to interact withthe first and second spinous processes.
 12. A spinous process device,comprising a fixation plate having a plurality of slotted openings; aplurality of fixation devices adjustably coupled to the slotted openingsand configured to be placed through openings created in a first andsecond spinous processes; and clamping washers configured to couple withthe fixation devices and secure the fixation plate to the spinousprocesses in the desired compression or distraction position.
 13. Thedevice according to claim 12, wherein the fixation devices are selectedfrom a group consisting of: screws, bolts, pins, springs, rods, andother suitable devices.
 14. A spinous process device, comprising: afirst plate configured to be pivotally coupled to a second plate; aclamping mechanism configured to couple the first plate to the secondplate upon pivotal movement of the plates toward each other; and aplurality of protrusions disposed on at least one of the plates andconfigured to interact with spinous processes to be secured by theplates; wherein the spinous processes are positioned between the plates.15. A spinous process device, comprising: a first plate having a firstpart rotatably and translationally coupled to second part along a firstpivot axis; a first arm extending transversely from the first partrelative to the first pivot axis configured to extend between a firstand second spinous processes; a second plate having a third partrotatably and translationally coupled to a fourth part along a secondpivot axis; a second arm extending transversely from the third partrelative to the second pivot axis configured to extend between the firstand second spinous processes; and a coupling mechanism configured toengage the first and second arms and angularly and translationallycouple the first and second plates.
 16. The device according to claim15, wherein the first arm comprises a rod and the coupling mechanismcomprises a clevis having a body with an aperture, the body beingcoupled to the second arm and the aperture being coupled to the rod,wherein the distance between the first plate and the second plate isadjustable by sliding the rod relative to the second arm while the rodextends through the aperture of the clevis, and wherein the first partand the third part are rotatable relative to each other by rotating thesecond arm about the rod within aperture of the clevis.
 17. The deviceaccording to claim 15, wherein the coupling mechanism includes: a bodyhaving a first coupler opening, a second coupler opening, a thirdcoupler opening and a base opposite the first coupler opening, thesecond and third coupler openings being on opposite sides of the bodyand configured to receive the first and second arms; and a securingscrew coupled to the first couple opening configured to clamp the firstand second arms between the securing screw and the base.
 18. The deviceaccording to claim 15, wherein the first part comprises a first extendedportion receivable into a hollow interior portion of the second part andthe third part comprises a second extended portion receivable into ahollow interior portion of the fourth part, further comprising: a firstsecuring screw coupling the first part to the second part; and a secondsecuring screw coupling the third part to the fourth part.
 19. Thedevice according to claim 15, wherein at least one of the first part,second part, third part and fourth part includes an interior surfacewith a plurality of protrusions configured to interact with the spinousprocess.
 20. The device according to claim 15, wherein each of the firstpart, second part, third part and fourth part includes an instrumentcoupling hole.
 21. A spinous process device, comprising: a first plateextending along a first pivot axis comprising: a first part configuredto abut a first spinous process; a second part configured to abut asecond spinous process, wherein the first part is slidably coupled tothe second part along the first pivot axis and the second part isrotatable relative to the first part; a second plate extending along asecond pivot axis comprising: a third part configured to abut the firstspinous process opposite the first part; and a fourth part configured toabut the second spinous process opposite the second part, wherein thethird part is slidably coupled to the fourth part along the second pivotaxis and the fourth part is rotatable relative to the third part; and acoupling mechanism configured to couple the first and second plates suchthat: the distance between the first plate and the second plate isadjustable; and the first part and the third part are rotatable relativeto each other.
 22. The device according to claim 21, wherein the firstpart comprises a first member extending toward the third part, and thethird part comprises a second member extending toward the first part,wherein the first member is coupled to the second member with thecoupling mechanism that allows the first member to translate axially androtate relative to the second member to establish a spaced distancebetween the first part and the third part and to establish an angularrelationship between the first part and the third part.
 23. The deviceaccording to claim 22, wherein the coupling mechanism comprises aclevis, the clevis comprising an aperture, a body and a threaded end,wherein the first member is a rod and the second member is an arm, therod being coupled to the arm with the rod extending through the apertureand translating axially through the aperture to establish a spaceddistance between the first part and the third part, and the arm rotatesabout the clevis body to establish an angular relationship between thefirst part and the third part.
 24. The device according to claim 22,wherein the coupling mechanism comprises a hollow cylinder having afirst opening, a second opening, and a third opening, the first memberis a first arm and the second member is a second arm comprising athreaded hole, wherein the first plate is coupled to the second platewith the first arm received in the second opening of the hollowcylinder, the second arm received in the third opening of the hollowcylinder, and wherein a securing screw extends into the first opening ofthe hollow cylinder and engages the threaded hole in the second arm. 25.The device according to claim 21, wherein at least one of the firstpart, second part, third part and fourth part includes an interiorsurface with a plurality of protrusions configured to interact with thespinous processes.
 26. The device according to claim 21, wherein each ofthe first part, second part, third part and fourth part includes aninstrument coupling hole.
 27. A method of clamping adjacent spinousprocesses comprising: providing a spinous process device comprising: afirst plate having a first part slidably coupled to a second part; asecond plate configured to be placed oppositely to the first plate andhaving a third part slidably coupled to a fourth part; and first andsecond connector devices configured to be placed through openingscreated in the spinous processes and couple first and second parts ofthe first plate to second and third parts of the second plate together;creating openings in the spinous processes at a predetermined distanceapart to receive the first and second connector devices; adjusting thedistance between the first and second parts of the first plate and thesecond and third parts of the second plate so that the first and secondconnector devices are aligned with the openings in the spinousprocesses, the spinous processes being disposed between the plates; andsecuring the first and second plates to the spinous processes with thefirst and second connector devices, thereby compressing and clamping thespinous processes between the first and second plates.
 28. A method ofclamping adjacent spinous processes of a patient, comprising: providinga spinous process clamping device comprising: a first part and a secondpart slidingly coupled to form a first plate; a third part and a fourthpart slidingly coupled to form a second plate; a coupling mechanismconfigured to couple the first and second plates to allow for adjustmentof distance and relative rotation between the first and second plates;inserting the spinous process clamping device adjacent at least twoadjacent spinous process with the first plate provided on one side ofthe two adjacent spinous processes and the second plate provided on theother side of the two adjacent spinous process; clamping the first plateand second plates to the opposite sides of the two adjacent spinousprocesses, wherein said clamping comprises: adjusting lengths of thefirst plate and the second plate by sliding the first part relative tothe second part and sliding the third part relative to the fourth part,respectively, to a desired length for placement of the first and secondplates against the two adjacent spinous processes; adjusting an angularrelationship of the first and second parts of the first plate bytwisting the first part relative to the second part, and adjusting theangular relationship of the third and fourth parts of the second plateby twisting the third part relative to the fourth part, to conform tothe shape of the adjacent spinous processes; and adjusting an angularrelationship of the first plate relative to the second plate via thecoupling mechanism connecting the first plate to the second plate, toconform to the shape of the adjacent spinous processes.